SciELO - Scientific Electronic Library Online

vol.107 número3Nuevas tendencias en el manejo de la diverticulitis y la enfermedad diverticular del colonVólvulo gástrico agudo: a propósito de un caso índice de autoresíndice de materiabúsqueda de artículos
Home Pagelista alfabética de revistas  

Servicios Personalizados




Links relacionados

  • En proceso de indezaciónCitado por Google
  • No hay articulos similaresSimilares en SciELO
  • En proceso de indezaciónSimilares en Google


Revista Española de Enfermedades Digestivas

versión impresa ISSN 1130-0108

Rev. esp. enferm. dig. vol.107 no.3 Madrid mar. 2015




Acral injury as first manifestation of a metastatic adenocarcinoma of the colon

Lesión acral como primera manifestación de un adenocarcinoma de colon metastásico



Laura Valiente-González, Teresa Martínez-Pérez, Yolanda Jiménez-Martínez, Raquel Martínez-Fernández, Miriam Viñuelas-Chicano, Carmen Julia Gómez-Ruiz, José Ignacio Pérez-García, Julia Morillas-Ariño, Gracia Pérez-Vigara, Jesús García-Cano-Lizcano and Ángel Pérez-Sola

Department of Digestive Diseases. Hospital Virgen de la Luz. Cuenca, Spain



Case report

A 56-year-old woman suffered from a painful lesion in the distal phalanx of the left second finger for two months that affected both the skin and nail (Fig. 1). At the same time she presented also with hairless plate lesion in the occipital region (Fig. 2).




She received antibiotics without improvement. Consequently, a biopsy was taken from the nail lesion. Histopathology showed nail infiltration from a mucus secreting adenocarcinoma being suggestive of metastasis from intestinal origin.

Further investigation in the Gastroenterology Department discovered by means of colonoscopy a stenosing neoplasia at the hepatic flexure. Cranial and body CT revealed also skin, brain, lung and liver metastases together with peritoneal carcinomatosis.

Palliative measures were undertaken. The patient passed away three months later.



Cutaneous metastases from visceral tumors are rare. They are found in less than 4 % of patients suffering from colorectal cancers (1,2). Cutaneous metastases are the first sign of asymptomatic neoplasias in 0.8-1 % of cases (3,4). Cutaneous metastases from colorectal cancers are usually located in the abdomen and had been also reported in limbs and the chest. Less frequently they can be found in the head and hands. Phalangeal metastases are particularly unusual (3). Therefore, acral metastases are very rare, being located in the hand in 0.1 %. They showed more preference for fingers (86 %) than toes. They were especially located in the thumb and distal phalanx (4).

Diagnosis is complicated because they can be confused with inflammatory or infectious benign lesions. Cutaneous metastases can present as nodules, ulcers and fibrous plates affecting the scalp. Neoplastic baldness zones can be found. Acral metastases are often very painful and can distort the phalanx. Besides they lead to nail destruction (4), doing more difficult a proper diagnose.

These metastases are often associated with widespread visceral involvement, rapid progression and poor prognosis (1,2). Schoenlaub et al. carried out a retrospective review of 200 patients and concluded that survival in patients with cutaneous metastases had a mean 6.5 months. This figures were lower (4.4 months) in cases of colon metastases (5).



1. Schoenlaub P, Sarraux A, Grosshans E, Heid E, Cribier B. Survival after cutaneous metastasis: A study of 200 cases (in French). Ann Dermatol Venreol 2001;128:1310-5.         [ Links ]

2. Lo Russo G, Accarpio F, Spinelli GP, Miele E, Borrini F, Cerbone L, et al. Subcutaneous metastases from colon cancer. J Med Case Reports 2012;6:212.         [ Links ]

3. Civitelli S, Civitelli B, Martellucci J, Tanzini G. Diffuse cutaneous metastases as the only sign of extranodal tumor spread in a patient with adenocarcinoma of the colon. ISRN Surg 2011;2011:902971.         [ Links ]

4. Lee TG, Lee SJ. Unusual case of solitary perineal subcutaneous metastasis from sigmoid colon cancer. Ann Coloproctol 2013;29:34-7.         [ Links ]

5. García Arpa M, Rodriguez Vazquez M, Sánchez Caminero P, Delgado M, Vera E, Romero G, et al. Metastasis digital acral. Actas Dermosifiliogr 2006;97:334-6.         [ Links ]

Creative Commons License Todo el contenido de esta revista, excepto dónde está identificado, está bajo una Licencia Creative Commons